The invention relates devices for performing vascular anastomosis, and more particularly to cuff manipulator tools used to grasp an anastomosis cuff during vascular anastomosis.
Many types of surgery require vascular anastomosis. During this procedure, the cut ends of two vessels are joined together such that blood can flow through the joined vessels. Vascular anastomosis is common in transplant surgery when the vessels of the donor organ are attached to existing vessels in the patient. Vascular anastomosis is also common when a severed extremity is reattached to a patient.
FIG. 1 shows a cuff 50 suitable for use in a vascular anastomosis procedure. Because the cuff 50 is cylindrical in shape, securely holding the cuff with a single pair of forceps (or a hemostat) 52 can be difficult. Because the single pair of forceps 52 only touches two points on the exterior of the cylindrical cuff 50, the cuff is free to rotate around those two points. In order to securely hold the cuff 50, a second pair of forceps (or a second hemostat) 54 must be used to grasp the cuff at a different angular orientation. By grasping the cuff with two pairs of forceps, the cuff can be securely held. Unfortunately, using two pairs of forceps is awkward and may require two hands, thus making any additional procedures very difficult.
FIG. 2 shows another type of anastomosis cuff 60, which has an extending tab 62. The extending tab 62 can be grasped by a single pair of forceps to hold the cuff relatively stable. However, because the walls of the cuff 60 are relatively thin, the extending tab 62 can flex relative to the main body of the cuff 60 when forces are applied to the cuff during an anastomosis procedure. The movement of the cuff 60 due to the flexing makes it difficult perform the anastomosis procedure. In addition, the location of the extending tab 62 makes the tab difficult to grasp, and may cause interference between the tab and surrounding body tissue.
FIGS. 3A-3D illustrate a typical anastomosis procedure using a prior art cuff 50. As shown in FIG. 3A, a cuff 50 is first fitted over a severed end 72 of a vessel 70. The cuff is then grasped with one or more pairs of forceps (not shown) and the end 72 of the vessel 70 is turned inside out around the end of the cuff 50, as shown in FIG. 3B. During this procedure, the cuff 50 must be held relatively steady to allow the end 72 of the vessel 70 to be turned inside out over the cuff 50. The enverted end 72 of the vessel 70 is then sutured to the cuff 50 with sutures 74 to immobilize the enverted end 72. The mating end of a second vessel 78 is then brought adjacent the enverted end 72 of the first vessel 70, as shown in FIG. 3C. Next, the end of the second vessel 78 is passed over the enverted end 72 of the first vessel 70, as shown in FIG. 3D. The second vessel 78 is then slid down over the enverted end 72 of the first vessel 70 and a circular suture 80 and knot 82 is placed around both of the vessels to hold the vessels securely together.
Because it is difficult to hold the cuff immobile during the anastomosis procedure, slippage of the cuff can occur during the procedure. This is particularly problematic if the exterior of the cuff is wet, or if the forceps are held at an imperfect angle. If two pairs of forceps are used to grasp the cuff at different angles, the vessel must be accessible enough for each pair of forceps to surround the cuff from different sides. If excessive pressure is applied to a cuff in an attempt to firmly grasp the cuff, the cuff may collapse, potentially ruining the underlying portion of the vessel.